Use of Ilizarov external fixation for a periprosthetic supracondylar femur fracture

Supracondylar femur fractures above a total knee replacement are rare injuries that may be challenging to treat. We present a case of an elderly woman whose supracondylar femur fracture was not deemed amenable to conventional treatment. This patient underwent fixation of her femur fracture above a total knee replacement using an Ilizarov external fixator. The fixator was removed at 10 weeks, at which time the fracture was solidly healed. At the most recent follow-up, the patient is 19 months postinjury. She is fully weight bearing without walking aids and has a knee range of motion of 0° to 110°.     

An alternative treatment for osteoporotic Su Type III periprosthetic supracondylar femur fractures: Double locking plate fixation

Introduction

Patients with Su Type III fractures based on total knee arthroplasty (TKA) constitute a patient group with problematic treatment and management. Although it has difficulties, open reduction and internal fixation is one of the treatment options.

Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty

Simulated supracondylar fractures were created proximal to posterior cruciate ligament-retaining total knee arthroplasty components in paired human cadaver femora and stabilized with either a retrograde-inserted locked supracondylar nail or the Less Invasive Stabilization System (LISS; Synthes USA, Paoli, PA). Loads were applied to create bending and torsional moments on the simulated fracture stabilized with either no gap or a 10-mm gap. The LISS exhibited less torsional stability with anterior (P<.001) and posterior loads (P<.01). When varus loads were applied to 10-mm-gap specimens, the specimens stabilized with a retrograde nail had an 83% reduction in fracture displacement (P<.001) and 80% less medial translation of the distal fragment (P<.001). The samples stabilized with the LISS had a 93% reduction in fracture gap displacement when a valgus load was applied with a 10-mm gap (P<.001). Overall, these results suggest that the retrograde-inserted nail may provide greater stability for the management of periprosthetic supracondylar femur fractures in patients with a posterior cruciate ligament-retaining femoral total knee arthroplasty component.     

Biomechanical evaluation of fracture fixation constructs using a variable-angle locked periprosthetic femur plate system

Background

In the United States there are more than 230,000 total hip replacements annually, and periprosthetic femoral fractures occur in 0.1–4.5% of those patients. The majority of these fractures occur at the tip of the stem (Vancouver type B1). The purpose of this study was to compare the biomechanically stability and strength of three fixation constructs and identify the most desirable construct.

Methods

Fifteen medium adult synthetic femurs were implanted with a hip prosthesis and were osteotomized in an oblique plane at the level of the implant tip to simulate a Vancouver type B1 periprosthetic fracture. Fractures were fixed with a non-contact bridging periprosthetic proximal femur plate (Zimmer Inc., Warsaw, IN). Three proximal fixation methods were used: Group 1, bicortical screws; Group 2, unicortical screws and one cerclage cable; and Group 3, three cerclage cables. Distally, all groups had bicortical screws. Biomechanical testing was performed using an axial–torsional testing machine in three different loading modalities (axial compression, lateral bending, and torsional/sagittal bending), next in axial cyclic loading to 10,000 cycles, again in the three loading modalities, and finally to failure in torsional/sagittal bending.

Results

Group 1 had significantly greater load to failure and was significantly stiffer in torsional/sagittal bending than Groups 2 and 3. After cyclic loading, Group 2 had significantly greater axial stiffness than Groups 1 and 3. There was no difference between the three groups in lateral bending stiffness. The average energy absorbed during cyclic loading was significantly lower in Group 2 than in Groups 1 and 3.

Conclusions

Bicortical screw placement achieved the highest load to failure and the highest torsional/sagittal bending stiffness. Additional unicortical screws improved axial stiffness when using cable fixation. Lateral bending was not influenced by differences in proximal fixation.

Clinical relevance

To treat periprosthetic fractures, bicortical screw placement should be attempted to maximize load to failure and torsional/sagittal bending stiffness.     

Biomechanical comparison of two angular stable plate constructions for periprosthetic femur fracture fixation

Purpose

Fractures of the femur associated with total hip arthroplasty are a significant concern in orthopaedic and trauma surgery. However, little is known about the different biomechanical properties of internal fixation systems in combination with periprosthetic fractures. In this study two new internal fixation systems for periprosthetic fractures are investigated using a cadaver fracture model simulating a Vancouver B1 periprosthetic femur fracture.

Methods

Nine pairs of fresh-frozen cadaver femurs were scanned by dual X-ray absorptiometry. Cementless total hip prostheses were implanted and a periprosthetic femur fracture was simulated. Fractures were randomly fixed either with the fixed angle locking attachment plate (LAP®, Depuy Synthes®, Solothurn, Switzerland) or the variable angle non-contact bridging plate (NCB®, Zimmer GmbH, Winterthur, Switzerland). Each construct was cyclically loaded to failure in axial compression.

Results

Axial stiffness and cycles to failure were significantly higher in the NCB group. Both systems were able to be fixed well around the femoral stem.

Conclusion

The two different internal fixation systems for periprosthetic fractures differed significantly in our setup. The non-contact bridging plate system revealed significantly higher failure load and may be the preferred option where high stability and load capacity is needed right after operation.     

Risk factors for failure after treatment of a periprosthetic fracture of the femur

Periprosthetic fracture of the femur is an uncommon complication after total hip replacement, but appears to be increasing. We undertook a nationwide observational study to determine the risk factors for failure after treatment of these fractures, examining patient- and implant-related factors, the classification of the fractures and the outcome.Between 1979 and 2000, 1049 periprosthetic fractures of the femur were reported to the Swedish National Hip Arthroplasty Register. Of these, 245 had a further operation after failure of their initial management. Data were collected from the Register and hospital records. The material was analysed by the use of Poisson regression models.It was found that the risk of failure of treatment was reduced for Vancouver type B2 injuries (p = 0.0053) if revision of the implant was undertaken (p = 0.0033) or revision and open reduction and internal fixation (p = 0.0039) were performed. Fractures classified as Vancouver type B1 had a significantly higher risk of failure (p = 0.0001). The strongest negative factor was the use of a single plate for fixation (p = 0.001). The most common reasons for failure in this group were loosening of the femoral prosthesis, nonunion and re-fracture.It is probable that many fractures classified as Vancouver type B1 (n = 304), were in reality type B2 fractures with a loose stem which were not recognised. Plate fixation was inadequate in these cases. The difficulty in separating type B1 from type B2 fractures suggests that the prosthesis should be considered as loose until proven otherwise.     

髋关节置换术后股骨骨折治疗的新选择

目的 总结钢板钢缆固定系统在髋关节置换术后股骨骨折治疗中的应用。方法 回顾分析1998年～2002年应用该系统治疗11例临床和影像资料，并对随访结果及影像资料进行评定。结果 8例假体稳定，骨折无畸形愈合；2例假体略微下沉，骨折无畸形愈合；1例钢板断裂内翻畸形，接受二次手术。结论 钢板钢缆固定是治疗髋关节置换术后假体周围骨折的有效方法之一。     

Epidemiology of periprosthetic femur fracture around a total hip arthroplasty

Periprosthetic femoral fractures can be classified as intraoperative and postoperative fractures. The intraoperative fractures mostly occur during the insertion of the femoral stem. Depending on the fixation method used, differences in the incidence of intraoperative fractures have been reported. An increase of intraoperative fractures is reported with the introduction of uncemented stems and this is often a consequence of the effort to obtain a sufficient press-fit to gain initial stem stability. In revision surgery an even higher incidence has been reported, ranging between 3.6% and 20.9% when cemented or uncemented prostheses are used, respectively. This review article reports on the prevalence of periprosthetic femoral fractures around a total hip replacement.     

形状记忆环抱接骨板在股骨假体周围骨折中的应用

目的 探讨形状记忆环抱接骨板治疗人工髋关节置换术后股骨假体周围骨折的临床疗效.方法 对4例人工髋关节置换术后发生同侧股骨假体周围骨折采用形状记忆环抱接骨板固定3例(VancouverB1型),骨水泥型加长柄人工股骨假体全髋翻修术1例(VancouverB2型).结果 4例均获随访,时间8～18(13±5)个月.4例切口均一期愈合,骨折临床愈合时间(6±2)个月.术后Harris评分,3例B1型平均(89±4)分,1例B2型75分.结论 形状记忆环抱接骨板治疗人工髋关节置换术后股骨假体周围骨折(VancouverB1型)具有固定牢靠、操作简单、创伤较小、术后并发症少等优点,是一种实用可靠的治疗方法,可获得良好的临床疗效.     

股骨髁上骨折内固定及其生物力学的研究进展

随着内固定器械的发展和完善,AO角钢板、动力髁螺钉、顺行髓内钉以及逆行髁上髓内钉相继出现,并得到广泛应用,有关几种内固定器械的生物机制研究也逐渐深入。现将近10年股骨髁上骨折内固定方法及生物机制的研究进展综述如下。1 股骨髁上骨折的内固定方法1.1 95°角钢板和DCS内固定 瑞士的AO学组设计的95°角钢板是最初应用于股骨髁上骨折的内固定器械之一。虽然角钢板对大部分髁上骨折提供了牢固固定,但股骨髁部要求三个平面同时准确定位。随后发展起来的DCS在技术上要求较低,ECS在屈伸平面固定不受限制,但DCS插钉时须去除骨量较大,这将使今后可能的翻修手术变得困难。Giles等和Pritcher以及最近的Ketterl等、Chrisovitisions等报道了DCS治疗股骨远端骨折的结果,优良率(50～86)％,不愈合率(0～5.7)％,畸形愈合率(5.3～11)％,约1/3骨折需植骨。Sanders等认为如果骨折线向近端延伸,骨折内侧应取髂骨植骨;对用简单钢板固定而不愈合的骨折,     

Operative management of periprosthetic femur fractures in the elderly using biological fracture reduction and fixation techniques

Treatment of periprosthetic femur fractures often requires deviation from standard fixation techniques due to the presence of associated arthroplasty components, however, the use of adjuvant bone grafts and bone graft substitutes remain controversial. 59 patients (average age, 74 years) with either a periprosthetic femoral shaft about an arthroplasty stem (n=29) or supracondylar fracture above a total knee arthroplasty (n=30) were treated with biological open-reduction internal-fixation techniques without the use of bone grafts or bone-graft substitutes. All except one patient healed after the index procedure. Three patients had progressive malalignment associated with failed screw fixation but all healed without further surgical intervention. 49 out of the 59 patients returned to their baseline level of function. These results indicate that use of adjuvant bone graft materials may not be routinely necessary when treating periprosthetic femur fractures using lateral plates and biological reduction and fixation techniques.     

双边单针外固定架加夹板治疗老年股骨髁上骨折

股骨髁上骨折是老年人的常见骨折类型,因老年人常合并有心脑血管病、糖尿病等内科疾病,给治疗方法的选择带来一定的限制[1-2]。我们在1998年9月-2005年12月应用自制外固定架配合夹板治疗老年股骨髁上骨折46例,取得满意疗效,现总结报告如下。1临床资料本组46例,男21例,女25例;年龄65~91岁,平均为78岁;自己摔伤30例,被车撞伤16例。横断骨折12例,粉碎性骨折34例;其中合并肺功能不全23例,心脏病37例,高血压32例,偏瘫9例,糖尿病16例,老年痴呆7例,合并2种以上疾病38例。2方法2·1外固定架的制作依据大腿上段形状制作2片宽15 cm半圆形铝合金片,内侧…     

Osteosynthesis of a periprosthetic fracture of the proximal femur with the distal femur LISS system

In this case report, we show how it is possible to perform osteosynthesis using minimal invasive techniques instead of conventional methods. In this instance the osteosynthesis was performed on a patient in poor general condition who had presented a periprosthetic fracture of the proximal femur. For the osteosynthesis the Less invasive Stabilization System intended for distal femur fractures was used with success.